Better pay, decent facilities top midwives’ wish list
Pregnant woman.
What you need to know:
- Jackline Chebet has been working as a midwife at Amudat Hospital in Uganda for the last 15 years and the work is not a bed of roses as it has been riddled by little pay and lack of opportunities for promotion.
- For the 15 years she has worked as a midwife, she has never been promoted and wishes the government can value midwives by giving them adequate pay and providing career development opportunities.
Jackline Chebet has been working as a midwife at Amudat Hospital in Uganda for the last 15 years.
Chebet says being a midwife is not a bed of roses as it has been riddled by little pay and lack of opportunities for promotion.
For the 15 years she has worked as a midwife, she has never been promoted and wishes the government can value midwives by giving them adequate pay and providing career development opportunities.
She adds that midwives lack accommodation, with some being forced to rent and reside outside health facilities, yet they are supposed to work at night.
“There is an urgent need to improve working conditions by providing accommodation at health facilities to avoid being forced to travel to a facility at night,” says Ms Chebet in a global report on midwives.
Florence Rwabahima, a retired midwife from Uganda, adds that the low number of midwives is a major problem that has resulted in serious workload in hospitals.
“When one midwife is responsible for 100 mothers, this creates stress and burnout. The government needs to recruit more midwives. This will make midwives very happy, and, consequently, they will provide higher quality and respectful care,” she says.
Moreen Ndanyo, a midwife from Kenya, notes that to give mothers all the services they need, there is a need to understand what midwives want.
“Midwives need better supplies and more funding—they should be involved in budget conversations because they are the ones who know what is required to reduce maternal mortality. Midwives deserve respect and appreciation for their expertise,” says Ms Ndanyo.
Another midwife working in Kakamega County notes that space and infrastructure are wanting in most of the facilities, making their work a nightmare.
“My labour ward is, for example, so small that if there are two mothers [in labour] and two colleagues, you keep running into each other. This impacts service delivery and infringes on the privacy of the client,” she says.
To arrest this embarrassing situation, she says, midwives need a partition in the labour ward to separate mothers in the first, second, and third stages of labour to make it much easier to provide the needed care.
These are just but a tip of the iceberg of the challenges that midwives in Kenya and other countries face. A new survey by White Ribbon Alliance (WRA), in collaboration with the International Confederation of Midwives (ICM), has reinforced the sentiments by the midwives.
Read: Celebrating midwives
Findings
The survey shows higher pay is the top global demand for midwives today, followed by the need for supplies and decent facilities.
The survey report, titled Midwives’ Voices, Midwives’ Demands, saw the involvement of over 56,000 midwives from 101 countries, among them 3,500 from Kenya. It recommends that governments tackle the global maternal health crisis by urgently investing in midwifery.
Besides the huge gaps in the workforce, the report indicates midwives face discrimination, unequal pay, and difficult working conditions, meaning they are unable to work to their full potential and provide life-saving care to women, newborns, and people in communities.
The need for supplies and decent facilities tops the demands by midwives and nurses in Kenya, Ghana, India and Nigeria.
The report also indicates that despite their importance, midwives still make up less than 10 per cent of the global sexual, reproduction, maternal, newborn, adolescent health (SRMNAH) workforce, with healthcare systems around the globe failing to invest in hiring, educating, training, paying, and supporting midwives.
Overworked
“Midwives who are working in the field must daily bear the brunt of a system that leaves them exhausted and overworked. As a result, many midwives take on secondary jobs to support themselves and their families. Many eventually leave the midwifery workforce entirely.”
Ms Kristy Kade, the WRA chief executive, regrets that midwives remain at the bottom of the pay ladder, even as they literally shoulder the costs of supporting women and families—from delivering babies to treating survivors of gender-based violence—in places where there would otherwise be no services.
“Midwives are frequently not reimbursed through government insurance programmes or are required to purchase medicines and supplies for their patients out of pocket,” says Ms Kade.
Angela Nguku, WRA deputy CEO and a former practising midwife, notes that many midwives walk away from their profession with a broken heart, simply looking to survive. Ms Nguku is now a full-time advocate.
“For midwives, what they want is clear: To be paid a living wage, with benefits. Because if we cannot meet midwives’ basic needs (funds, food, shelter, clean water), we cannot expect them to meet the needs of women, birthing people, newborns, and families. The ever-increasing midwifery shortage is making it clear that midwives will not meet those needs any longer,” she says.
Top demands by midwives in Kenya include enhancing of supplies and functional facilities, access to protective equipment and gear, availability of delivery beds, hiring of more and better supported personnel and increasing salaries.
Deaths due to pregnancy, childbirth
About 300,000 women and girls die during pregnancy and childbirth yearly, but—according to UNFPA—82 per cent of the deaths could be prevented if midwives were available to everyone.
Beyond saving lives, a recent analysis by UNFPA indicates that fully qualified and regulated midwives, who are integrated within and supported by interdisciplinary teams, can deliver around 90 per cent of SRMNAH interventions.
The most recently available data from the Kenya Demographic and Health Survey estimates that 362 maternal deaths occur per 100,000 live births. At the current estimated annual births, this translates into over 5,000 women and girls dying of pregnancy or birth complications.
Research by the Lancet from 2020 showed that fully resourcing midwife-delivered care by 2035 could avert 67 per cent of maternal deaths, 64 per cent of newborn deaths, and 65 per cent of stillbirths.
According to the State of the World’s Midwifery Report 2021, the world currently needs 900,000 more midwives, representing a third of the required global midwifery workforce. The report adds increased investment in midwives could save up to 4.3 million lives annually by averting 67 per cent of maternal deaths, 64 per cent of neonatal deaths, and 65 per cent of stillbirths globally.
In 2019, WRA launched the campaign dubbed What Women Want: Demands for Quality Healthcare from Women and Girls, which asked more than one million women and girls in 114 countries what their one request for maternal and reproductive healthcare was.
Nearly 145,000 women and girls asked for increased, competent, and better supported healthcare workers, with “nurses and midwives” most often mentioned.
Nurses and midwives were among the top five requests from all women and girls, and even top three for women aged 20 to 24.
